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4 <br /> 7. Program Income <br /> a) Amount of existing program income: $ N/A <br /> b) Amount of anticipated program income: $ <br /> c) If program income exists or is anticipated,describe the proposed application(s) <br /> S. Unpaid Costs and Unsettled Third Part),Claims <br /> List any unpaid costs and unsettled third party claims against the recipients grant Describe the circumstances and amounts involved. <br /> N/A <br /> 9. Remarks For DCA Use Only) <br /> 10. Certification of 12ecipienl <br /> It is hereby certified that all activities undertaken by the Recipient with funds provided under the grant agreement identified on page I <br /> hereof,have,to the best of my knowledge,been carried out in accordance with the grant agreement; that proper provisions have been <br /> made by the Recipient for the payment of all unpaid costs and unsettled third patty claims identified on page I hereof. that the State of <br /> North Carolina is under no obligation to make any further payment to the Recipient under the grant agreement in excess of the amount <br /> identified on Line 7 hereof;and that every statement and amount set forth in this instrument is,to the best of lily knowledge,true and <br /> correct as of this date. <br /> Date Typed Name and Title of Recipient's Signature of Recipient's <br /> Authorized Representative Authorized Representative <br /> Name: William Crowther <br /> Title:Chair,Orange County Bd. of Comm. <br /> 11. DCA Approval <br /> This Certification of Completion is hereby approved. Therefore,I authorize cancellation of the unutilized contract commitment and <br /> related funds reservation and obligation of $ , less$ _ previously authorized for <br /> cancellation(from Section 6, line 6,page 1). <br /> Date Typed Name and Title of DCA Authorized Official Signature of DCA Authorized Official <br /> William A.McNeil <br /> Director,Division of Community/\ssistance <br /> Page 2 <br />